PRE-FRAILTY PREDICTS LOWER HEALTH-RELATED QUALITY OF LIFE IN HEART FAILURE PATIENTS

https://youtu.be/eYVlNwOPAm8 BACKGROUND: Pre-frailty and impaired cardiorespiratory fitness (peakVO2) are common in heart failure (HF) patients and are associated with reduced health-related quality of life (HRQOL). However, the independent contribution of pre-frailty to HRQOL, beyond the effects of peakVO2, remains unclear. Thus, the purpose of this study was to determine whether pre-frailty status was independently associated with lower HRQOL among individuals with HF compared to those classified as robust. METHODS: In a prospective, cross-sectional cohort of HF patients referred for cardiopulmonary exercise testing (CPET), participants completed a Modified Fried Frailty Test and the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) to assess HRQOL. Patients were classified as robust (score = 0) or pre-frail (score = 1–2). New York Heart Association (NYHA) and Left Ventricular Ejection Fraction (LVEF) were obtained from electronic medical records. Multivariable linear regression was used to assess whether pre-frailty was independently associated with KCCQ-12 overall scores, after adjusting for peakVO2, age, sex, BMI, and LVEF. RESULTS: Eighty-six pre-frail (61 males) and 51 robust (33 males) participants who completed a treadmill CPET with a respiratory exchange ratio (RER) >=1.05 were included for analysis. Among participants, objective and subjective measures contributed to pre-frailty status, with the most common contributing criteria being low grip strength (64%) and self-reported low energy (60%). There were no significant differences between groups in age (61.1 ± 12.4 vs. 58.1 ± 11.8 years), BMI (28.1 ± 5.6 vs 27.6 ± 5.3 kg/m2), NYHA Class II-III (76% vs. 61%), or prevalence of HF with reduced ejection fraction (60% vs. 53%). However, pre-frail participants had significantly lower peakVO2 (18.7 ± 6.4 vs. 21.3 ± 7.2 mL/kg/min, p = 0.01) and KCCQ-12 scores (74.7 ± 21.0 vs 86.2 ± 12.1, p < 0.001). No differences were seen in VE/VCO2 nadir or RER. Pre-frailty was independently associated with lower KCCQ-12 scores (β = -8.03, 95% CI [-14.02, -2.04], p = 0.009), adjusting for other covariates. Other significant associations included age (β = 0.39 per year, 95% CI [0.13, 0.64], p = 0.003) and peakVO2 (β = 1.09 per ml/kg/min, 95% CI [0.58, 1.60], p < 0.001). Female sex (β = -0.50, 95% CI [-6.30, 7.60], p = 0.88), LVEF (β = -0.14 per kg/m², 95% CI [-0.67, 0.45], p = 0.17), and higher BMI (β = -0.11 per kg/m², 95% CI [-0.34, 0.06], p = 0.69) were not significantly associated with KCCQ-12 scores. CONCLUSION: Pre-frailty is independently associated with poorer HRQOL in patients with HF, even after adjusting for peakVO2 and clinical covariates, highlighting the importance of frailty assessment in this population.